World Breastfeeding Week: HIV positive moms can celebrate too!

There are certain topics that seem to be “off limits” in discussions with other new parents.  Unless I already know that a mom feels the same way I do, there will be places in our conversation where I self-censor because she may have different views or a different approach, and I don’t want to seem “pushy”.  Breastfeeding is one of those topics.  Many women feel very strongly about breastfeeding and many don’t.  Some women who feel strongly don’t have much of a choice anyway, because it’s just not working for them or for baby, or because they don’t have the right kind of support.  For women living with HIV, there has been even less choice involved, as breastfeeding is one of the ways that HIV can be transmitted from mother to child.  Some recent studies show that mother-to-child transmission (MTCT) during breastfeeding is significantly reduced when the mother is taking antiretroviral treatment (ARVs).  The World Health Organization (WHO) has promised to change its HIV and breastfeeding recommendations before the end of the year, giving HIV positive women more choice when it comes to feeding their babies.

Without ARVs, about 25% of babies born to HIV positive mothers will contract the virus through MTCT.  One-third to one-half of these transmissions are thought to be via breast milk while the rest take place during pregnancy or delivery.  The WHO has recommended since 2006 that mothers living with HIV formula-feed their babies if it is safe and possible to do so.  This can be complicated in places where there is no clean drinking water to prepare formula or no place to keep it cool once it’s made.  There are also women who, because of work, are not in a position to take 15 to 30 minutes up to twelve times a day to boil water and mix formula.  And of course, many women simply can’t afford the formula itself.

Recommendations got even more complicated when studies began to show that exclusive breastfeeding in the first three months of baby’s life was better (in terms of avoiding HIV transmission) than mixed feeding.  It seems that the milk of HIV positive mothers contains factors that actually help protect the baby from infection and feeding them other food and/or water while also breastfeeding undermines this protection.  Other factors like the duration of breastfeeding, whether the mother suffers from mastitis or cracked nipples and whether the baby has thrush, also affect transmission rates.  So, the WHO recommendations currently say that where a safe and consistent alternative to breast milk (i.e. clean water and formula) is not available, babies should be exclusively breastfed until six months.  If safe drinking water is available, formula-feeding has been recommended because, of course, there is zero risk of HIV transmission via formula.

While the exciting new study doesn’t contradict these facts, it does indicate that ARVs quite successfully prevent HIV transmission during breastfeeding in the same way that they prevent it during pregnancy and childbirth.  Another factor contributing to MTCT, which I have not mentioned above, is of course, the mother’s viral load.  Viral load is a bit of a hot topic recently in light of last year’s Swiss statement and the increasingly popular movement toward treatment as prevention.  The WHO and a number of international partners conducted a study of 824 pregnant HIV positive women in five different sites in Burkina Faso, Kenya and South Africa.  Mothers who received ARV treatment through the third trimester and up to a maximum of six months breastfeeding were significantly less likely to pass HIV on to their infants.  Successful antiretroviral (ARV) treatment reduces the mother’s viral load, making transmission less likely.  Project leader Dr Tim Farley told Reuters that “the results of this study show an almost two-fold reduction in the risk of HIV transmission during the breastfeeding period.”

I think this is exciting news and another step toward real choice and reproductive freedom for women living with HIV.

- Miriam

This was posted on Friday, August 7th, 2009 at 10:00 am and is filed under HIV Prevention, HIV Treatment, News . Feel free to respond, or trackback. Read our comments policy.

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  Rob Rasner Comic May 8, 2011 at 3:37 am

  Interesting; what about adding certain online videos to the info We think it can enhance our awareness thanks Furthermore whats the latest on Charlie Sheen incredible headlines…Salam ! Rob Rasner Comic

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